Signs and Symptoms
While the symptoms of fibromyalgia can be debilitating, they are not life threatening. Symptoms vary, depending on stress level, physical activity, time of day, and the weather. Pain is the primary symptom, found in virtually 100% of cases�?specifically, pain and tenderness in certain areas of the body when pressure is applied to them. These areas include:
Pain may be aching, burning, throbbing, or move around the body (migratory). Many patients also experience muscle tightness, soreness, and spasms. The patient may be unable to carry out normal daily activities, even though muscle strength is not affected. The pain is often worse in the morning, improves throughout the day, and worsens at night.
There are 18 tender points used in diagnosing FMS. These occur in pairs, clustering around the neck, shoulders, shoulder blades, lower back, elbows and knees. Patients may have other tender points, but only these 18 are used in diagnosis.
There have been reports of fibromyalgia in children. What may be considered “growing pains�?might in fact be fibromyalgia, especially if the child complains of having difficulty sleeping.
List of Fibromyalgia Symptoms
Widespread pain for more than 3 months.
Abdominal pain.
Bloating, gas, belching, pain and distension
Constipation.
Cognitive or memory impairment
Diarrhea.
Difficulty concentrating.
Dry eyes and mouth
Exercise intolerance
Headaches, sometimes migraines.
Irritable bladder
Irritable bowel syndrome.
Mood changes.
Muscle twitching
Muscle weakness
Numbness and tingling in hands, arms, feet, legs or face.
Problems performing multiple tasks at one time
Skin sensitivities
Tiredness in the morning or late in the day.
The feeling of swollen extremities
Frequent changes in eye prescription
Impaired coordination
Chronic runny nose
Sleep disorders (e.g., restless leg syndrome, sleep apnea)
Gastrointestinal (e.g., abdominal pain, bloating, gas, cramps, alternating diarrhea and constipation)
Chronic headaches (may include facial and jaw pain)
Heightened sensitivity to odors, loud noises, bright lights, various foods, medicines, and changes in weather
Painful menstrual periods (dysmenorrhea) and painful sexual intercourse(dyspareunia)
Frequent urination, strong urge to urinate, and painful urination (dysuria)
Rapid or irregular heart rate, and shortness of breath
Sensation of swelling (edema) in the hands and feet, even though swelling is not present
Generalized muscle pain, muscle tenderness, stiffness, and aching
Significant fatigue
Sleep disorder or Insomnia
Depression
Poor memory and concentration
Headache (tension or migraine)
Dizziness
Tingling of the extremities
Temporomandibular joint syndrome (TMJ)
Cold intolerance
Allergic reactions to drugs, chemicals, and environmental toxins.
Wide spread pain with tender points
Overall weakness
Unrefreshing sleep
Fatigue
Stiffness
Tension Headaches
Painful periods
Irritable colon
Complaints of swollen glands
"Fibro Fog"
Skin redness, mottling
Subjective numbness, swelling, tingling
Complaints of fever
Complaints of dry eyes
Depression
Anxiety
Restless leg syndrome
Irritable bladder
Chronic fatigue
Subjective soft tissue swelling
Changes in vision
Muscle and joint aches
Generalized Pain
Fatigue
Morning Fatigue
Stiffness
Tired proir to extertion
Sleep disturbances
Morning Stiffness
Headaches
Tenderness
Numbness and tingling
Swollen feeling of tissues
Dizziness
Sensitivity to noise
Sensitivity to smell
Easily stressed
Menstrual cramps (worse then normal
Dry Mouth
Inability to concentrate
Forgetful
Irritable Bowel Syndrome
Mood Swings
Blurred Vision
Heart Palpitations
Cold extremeties
Low Grade fever
Allergies
Restless Legs
Muscle Twitching
Tinitus
Night Sweats
Migranes
Breathing problems
Itchy skin
Rashes
TMJ
Other conditions frequently seen with FMS:
These conditions themselves are commonly present without FM, but are seen frequently enough with FM that there may be an overlapping link. The following conditions have been reported or observed to be commonly associated with FM.
Allergies. The majority of FM pations have some history of allergies, either themselves or family members. The offending allergenic substance may be any type of environmental allergen, such as dust or pollen. It may be a medication. We are not even certain what is the specific relationship between allergies and FM, but it may reflect involvement of the immune system.
Anxiety disorder and panic attacks. Many FM patients experience episodes of extreme anxiety and near-panic. They may feel their heart racing, their chest become tight, and find it difficult to get their breath. There may be a feeling of impending doom. An extreme sensitivity to adrenaline may be part of FM that causes the associated condition.
Concentration and memory problems. Studies have not shown any true pathology in one's thinking and memory with FM. However, many people with FM report difficulty retaining facts and, at times, become very frustrated and concerned by this. It appears that there is a problem with attention to specifics.
The chronic pain may divert our attention that would otherwise be used to initiate the process of forming memory. When conciously attending to a specific task or specific information, people with FM demonstrate normal learning and memory.
Depression. Depression is commonly seen in conditions that cause chronic pain, including FM. Usual symptoms of depression include low self-esteem, feeling of helplessness, thoughts of suicide, poor appetite, frequent crying spells, and more. People with FM who become clinically depressed need treatment of both the depression and the FM to get well again.
Dry Eyes Syndrome. Up to a third of patients with FM report dry eyes. Many have to use eye drops to prevent painful reddened eyes.
Headaches: tension, migraine, and combination. Tension headaches are also called muscle contraction headaches, which usually begin at the base of the neck and extend upward to the temples, often forming what is described as a band-like squeezing headache.
Migraine headaches are vascular headaches in which some event triggers the blood vessels to the brain to constrict and then dilate, leading to a severe headache, nausea, vomiting, eye pain, and other symptoms. Many people have headaches which have both tension and migraine features.
Irritable Bladder. The individual may feel like he or she has a bladder infection with frequent painful urination, but urine tests do not reveal any evidence of infection.
Irritable Bowel Syndrome or Spastic Colon. Nearly half of patients with FM have frequent bowel cramping, diarrhea, and constipation.
Mitral Valve Prolapse (MVP). MVP is a condition where one of the heart valves, the mitral valve, bulges excessively during the heartbeat. It can be diagnosed by listening with a stethoscope for the characteristic click-murmur, or it can be detected with a soundwave test called an echocardiogram. This condition can cause problems such as abnormal heart rhythm, but rarely so. In fact, most cardiologists feel that MVP is a benign condition that does not mean a bad heart disease is present.
Mark Pellegrino, M.D. conducted a study at the Ohio State University that showed that the majority of people with fibromyalgia also have MVP. Since the mitral valve is mostly connective tissue, it is possible that FM affects connective tissue other than the muscles, tendons, and ligaments.
Restless Legs Syndrome and Nocturnal Myoclonus. These related conditions are most prominent at night. Restless legs syndrome causes leg cramps, especially in the calves, and an intense feeling of restlessness in the leg, that is not relieved until the individual moves the leg, as in walking around. Nocturnal myoclonus is involuntary jerking that occurs during sleep. A neurologic mechanism, perhaps signals that don't get "turned off," may be responsible for both of these similar conditions.
Raynaud's phenomenon. This is characterized by intermittent attacks of white or blue discolorations of the fingers or toes. Cold or stress usually brings on these vascular changes.
Scoliosis. Curvature of the spine commonly develops in teenage girls for no apparent reason. Scoliosis is also seen in a number of neuromuscular diseases. Dr. Pellegrino has observed a number of patients who have scoliosis and FM.
Temporomandibular joint dysfunction (TMJD). This condition is characterized predominantly by painful jaws. Other symptoms of TMJ dysfunction include headaches, ringing in the ears, face numbness and dizziness.
Chronic Fatigue Syndrome. Many physicians believe chronic fatigue syndrome and fibromyalgia are actually the same thing. Chronic fatigue syndrome causes fatigue and pain, and it may be triggered by a virus. It is also associated with mild fever, sore throat, and swollen, painful lymph nodes, but severe fatigue and muscle pains are the predominant complaints.
Fibrocystic breast disease and endometriosis. Painful cysts in the breast and uterus are a frequent occurence in women. Although these cysts are benign, they can become so painful and prevalent that they ultimately require surgical removal. Both these conditions are also commonly seen in women with FM.
-- Mark J. Pellegrino, M.D., Fibromyalgia Managing the Pain 1993
Premenstrual Syndrome (PMS). If you have FM and have menstrual periods, you probably do have PMS. Most of the symptoms of PMS are just like those of FM, only worse: headache, insomnia, back pain, abdominal cramps, mental confusion, and emotional upset. As anyone who has ever experienced it can tell you, PMS is terrible. It can keep you home and in bed, it can make you a nervous wreck, it can make you a screaming shrew, or it can cause you to cry uncontrollably. FM accentuates these symptoms.
Reflux (Gerd). Esophageal reflux is a condition in which the contents of the stomach exert back pressure on the muscular valve between the stomach and the bottom of the esophagus, forcing liquified, partially digested food and stomach acid back into the esophagus. It is sometimes referred to as heartburn or acid indigestion. Reflux is a problem for many people who have FM.
Hypothyroidism. Because the classic symptoms of an underactive thyroid gland so closely mimic those of FM - muscle pain, weakness, morning stiffness, fatigue, water retention, constipation, Raynaud's phenomenon, cognitive problems, loss of libido, and depression - your doctor should test your thyroid function before deciding that FM is your problem, or your only problem. Many people with FM also have underactive thyroids. Treatment with thyroid replacement hormone should relieve the symptoms within a few weeks, if hypothyroidism is the only problem. Eating foods rich in iodine (especially seafood) helps strengthen the thyroid gland.
Lyme Disease. If you have enough symptoms to make you think you have FM, but not enough to qualify for a formal diagnosis (for example, not enough tender points, pain not sufficiently widespread or not having lasted long enough), ask your doctor to check you for Lyme disease. This is especially important if you have been in the woods recently.
Lyme disease is a bacterial infection that comes from being bitten by an infected tick. The tick may be gone, and there may be no signs of a bite, although if you notice it early enough you will see a red rash in a small circle, usually with a bull's-eye in the middle. Many symptoms of Lyme disease mimic those of FM. There is a test for Lyme's disease, but it is not very accurate. False negatives occur about 30% of the time; false positives occur in only 10% of cases.
Caught early enough, Lyme disease is cured in most cases by a 2-week course of the antibiotic docycycline. Most people diagnosed with chronic lyme disease actually have FM, triggered by Lyme disease. It should not come as a great surprise that sleep distubance caused by Lyme disease could be the triggering mechanism that brings on FM in susceptible people, but it would be a gross error to say that every case of FM is really a case of Lyme disease, or that Lyme disease causes FM.
Postpolio Syndrome. FM occurs frequently in people who suffer from postpolio syndrome (PPS). Indeed, it may be that some of the symptoms of PPS are fibromyalgia, or that postpolio syndrome is one more trigger for FM. The virus that causes polio kills a certain percentage of the motor neurons that carry messages from the spinal cord to the muscles.
The remaining neurons then take over the chore of bearing messages to the muscle fibers that were served by the killed neurons, giving each much more work to do than before the onset of polio. This is believed to make the neurons die early, causing the progressive weakness that characterizes postpolio syndrome, long after the virus is gone.
To the extent that postpolio symptoms are also symptoms of FM, the person with PPS can be made to feel better by being treated for FM. Unfortunately, the muscle weakness is as yet untreatable.
Free Forum Hosting
Important Announcement
First 